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Accuracy of cuff blood pressure and systolic blood pressure amplification
Tan V Bui1, Dean S Picone1, Martin G Schultz1
1Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia.
Insights
Automated blood pressure (BP) cuff measurements can be inaccurate due to variations in systolic BP (SBP) amplification. Correcting cuff BP for SBP amplification significantly improves accuracy and hypertension classification.
Area of Science:
- Cardiovascular Medicine
- Biomedical Engineering
- Hypertension Research
Background:
- Automated cuff measurement is the global standard for diagnosing hypertension.
- Concerns exist regarding the accuracy of automated cuff blood pressure (BP) measurements.
- Individual variability in systolic blood pressure (SBP) amplification from central to peripheral arteries may impact cuff BP accuracy.
Purpose of the Study:
- To determine if individual variability in SBP amplification relates to the accuracy of automated cuff BP.
- To investigate the impact of SBP amplification on the accuracy of cuff-measured BP compared to invasive measurements.
Main Methods:
- Invasive brachial BP and automated cuff BP were recorded in 795 participants undergoing coronary angiography.
- SBP amplification was measured invasively as the difference between brachial SBP and aortic SBP.
- Seven different automated cuff BP devices were used across five research sites.
Main Results:
- Automated cuff SBP was significantly underestimated compared to invasive brachial SBP (mean difference -7.6 mmHg).
- SBP amplification varied significantly among individuals (mean ± SD, 7.3 ± 9.1 mmHg) and explained 19% of the variance in cuff BP accuracy.
- Cuff BP accuracy was highest in individuals with the lowest SBP amplification.
- Correcting cuff BP for SBP amplification significantly improved accuracy against the intra-arterial standard and hypertension classification.
Conclusions:
- Individual SBP amplification is a critical factor influencing the accuracy of automated cuff BP measurements.
- Adjusting cuff BP readings for SBP amplification enhances diagnostic precision for hypertension.
- This finding has implications for refining BP measurement techniques and hypertension diagnosis.
Abstract:
Automated cuff measured blood pressure (BP) is the global standard used for diagnosing hypertension, but there are concerns regarding the accuracy of the method. Individual variability in systolic BP (SBP) amplification from central (aorta) to peripheral (brachial) arteries could be related to the accuracy of cuff BP, but this has never been determined and was the aim of this study. Automated cuff BP and invasive brachial BP were recorded in 795 participants (74% male, aged 64 ± 11 years) receiving coronary angiography at five independent research sites (using seven different automated cuff BP devices). SBP amplification was recorded invasively by catheter and defined as brachial SBP minus aortic SBP. Compared with invasive brachial SBP, cuff SBP was significantly underestimated (130 ± 18 mmHg vs. 138 ± 22 mmHg, p < 0.001). The level of SBP amplification varied significantly among individuals (mean ± SD, 7.3 ± 9.1 mmHg) and was similar to level of difference between cuff and invasive brachial SBP (mean difference -7.6 ± 11.9 mmHg). SBP amplification explained most of the variance in accuracy of cuff SBP (R2 = 19%). The accuracy of cuff SBP was greatest among participants with the lowest SBP amplification (ptrend < 0.001). After cuff BP values were corrected for SBP amplification, there was a significant improvement in the mean difference from the intra-arterial standard (p < 0.0001) and in the accuracy of hypertension classification according to 2017 ACC/AHA guideline thresholds (p = 0.005). The level of SBP amplification is a critical factor associated with the accuracy of conventional automated cuff measured BP.
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